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GENETIC DRIFT
Overview of German, Nazi, and Holocaust MedicineM. Michael Cohen Jr.*Department of Pediatrics, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
Received 14 December 2008; Accepted 5 February 2009
An overview of German, Nazi, and Holocaust medicine brings
together a group of subjects discussed separately elsewhere.
Topics considered include German medicine before and during
the Nazi era, such as advanced concepts in epidemiology, pre-
ventive medicine, public health policy, screening programs,
occupational health laws, compensation for certain medical
conditions, and two remarkable guidelines for informed consent
for medical procedures; also considered are the Nuremberg
Code; American models for early Nazi programs, including
compulsory sterilization, abusive medical experiments on prison
inmates, and discrimination against black people; two ironies in
US and Nazi laws; social Darwinism and racial hygiene; com-
plicity of Nazi physicians, including the acts of sterilization,
human experimentation, and genocide; Nazi persecution of
Jewish physicians; eponyms of unethical German physicians
with particular emphasis on Reiter, Hallervorden, and Pernkopf;
eponyms of famous physicians who were Nazi victims, including
Pick and van Creveld; and finally, a recommendation for con-
vening an international committee of physicians and ethicists
to deal with five issues: (a) to propose alternative names for
eponyms of physicians who exhibited complicity during the Nazi
era; (b) to honor the eponyms and stories of physicians who were
victims of Nazi atrocities and genocide; (c) to apply vigorous
pressure to those German and Austrian Institutes that have not
yet undertaken investigations to determine if the bodies of Nazi
victims remain in their collections; (d) to recommend holding
annual commemorations in medical schools and research in-
stitutes worldwide to remember and to reflect on the victims of
compromised medical practice, particularly, but not exclusively,
during the Nazi era because atrocities and acts of genocide
have occurred elsewhere; and (e) to examine the influence of
any political ideology that compromises the practice of medicine.
� 2010 Wiley-Liss, Inc.
Key words: Reich Guidelines of 1931; Nuremberg Code; US
prison inmates; social Darwinism; racial hygiene; genetics; sterili-
zation; human experimentation; genocide; eponyms; Ploetz; Hal-
lervorden; Pernkopf; Reiter; van Creveld; Pick; Waardenburg;
Seckel; Robinow
INTRODUCTION
During the 1980s, 1990s, and during the present century, a great
many articles, treatises, and books by historians, physicians, and
other scholars have been published about physician complicity
during the Nazi era [Geiderman, 2002]. This article provides an
overview of German, Nazi, and Holocaust medicine.
DEDICATION
This article is dedicated to the memory of Lucja Frey, a Jewishwoman neurologist, who was the first physician to describe theneurological condition that bears her name–Frey syndrome–before she became a victim of the holocaust.
How to Cite this Article:Cohen MM Jr. 2010. Overview of German,
Nazi, and Holocaust Medicine.
Am J Med Genet Part A 152A:687–707.
*Correspondence to:
Dr. M. Michael Cohen Jr., Department of Pediatrics, Faculty of Medicine,
Dalhousie University, 5981 University Avenue, Rm 5122, Halifax, Nova
Scotia, Canada B3H 1W2. E-mail: [email protected]
Published online 11 February 2010 in Wiley InterScience
(www.interscience.wiley.com)
DOI 10.1002/ajmg.a.32807
� 2010 Wiley-Liss, Inc. 687
GERMAN MEDICINE BEFORE AND DURING THEEARLY NAZI ERA
Given the atrocities committed by large numbers of Nazi physi-
cians, there is a natural revulsion of German medicine during that
era. However, in some respects the truth is quite different certainly
before the Nazi era and to some extent even during the early Nazi era
[Wynia and Wells, 2007].
Before and during the early Nazi era, Germany led the world
in epidemiology, preventive medicine, public health policy,
screening programs, occupational health laws, compensation for
certain medical conditions, and informed consent for medical
procedures, and Germany did this many decades before the United
States.
Germany was exceptionally advanced in basic sciences and
clinical medicine [Wynia and Wells, 2007]. German medical edu-
cation, influenced by the Flexner report in the United States,
became the model system for the world [King, 1984]. By the
1930s, Germans held half the Nobel prizes awarded up to that
time [Proctor, 2003].
Box 1: Regulations on New Therapy and Human Experimentation* Reich Guidelines Circular, February 28, 1931
The Reich Health Council is issuing the following important guidelines for all physicians, who should sign a commitment to these
principles on entering their places of work.
(1) Sometimes in advancing medical science, novel procedures may be introduced, which involve scientific experimentation on
humans in an attempt to diagnose, treat, or prevent certain diseases. The physician must carefully weigh out his responsibility for
the life and health of any patient before he considers performing innovative treatment or scientific experimentation.
(2) Innovative treatment specifically refers to therapeutic procedures on humans that have not been sufficiently evaluated on the basis
of present knowledge or experience.
(3) Scientific experimentation specifically refers to interventions or treatment methods on humans for research purposes without
serving therapeutic purposes and whose effects cannot be sufficiently evaluated on the basis of present knowledge or experience.
(4) Any novel treatment must be justified and must be performed according to the principles of medical ethics and of medical practice
and theory. The anticipated benefits must be weighed out against possible adverse effects.
(5) Innovative treatment may only be carried out after the patient or his legal representative has unambiguously consented to the
procedure based on the relevant information provided in advance. When consent is refused, therapy can only be initiated if it is
urgent to preserve life, prevent serious damage to health, or prior consent could not be obtained under the circumstances.
(6) Particular care must be taken of whether or not to use innovative treatment on children or any person under 18 years of age.
(7) Exploiting social hardship to undertake innovative therapy is incompatible with the principles of medical ethics.
(8) Extreme caution is indicated for any innovative therapy involving microorganisms, particularly live pathogens. Such therapy is
only permissible if the procedure can be assumed to be relatively safe, and similar benefits are unlikely to be achieved by any other
method.
(9) In clinics, hospitals, and other health care facilities, innovative therapy may only be carried out by the physician-in-chief or
another physician designated by him in accordance with his specific instructions.
(10) A report must be filed of any innovative therapy, the purpose of the procedure, its justification, and the manner in which it was
carried out. A statement with full disclosure must be added that the patient, or when appropriate his legal representative, has been
provided with the necessary information in advance, and that consent was given. Full details must also be filed in those instances in
which consent was refused or could not be obtained, but urgent innovative therapy was necessary to preserve life or to prevent
serious damage to health.
(11) The results of any innovative therapy may be published provided the patient’s dignity is respected and the name is not used.
(12) Requirements for human experimentation:
(a) Human experimentation is prohibited in all cases in which consent has not been given.
(b) Experimentation involving human subjects must be avoided if animal studies will suffice.
(c) Experimentation involving children or youngsters under 18 years of age is prohibited if it endangers them in any way.
(d) Experimentation on dying subjects is unethical and is prohibited.
(13) Physicians, particularly those in charge of hospitals, should be guided by a strong sense of responsibility towards their patients.
However, they may also seek new ways of protecting or treating patients or alleviating their suffering if they are convinced that
known medical methods are likely to fail.
(14) Academic training courses should stress the physician’s special role when carrying out any novel form of therapy or scientific
experiment, as well as publishing the results in an ethical manner.
*Reichsgesundheitblatt 11, No. 10 (March, 1931), 174–175. First English translation: International Digest of Health Legislation 31:408–411, 1980. The
translation is too literal and is difficult to read. I have paraphrased it in modern English so that its contents can be better understood by readers.
688 AMERICAN JOURNAL OF MEDICAL GENETICS PART A
The electron microscope, a German invention, was used to
document asbestosis and its link to lung cancer. A newly introduced
occupational law required compensation for workers with
asbestos-related disease. A large epidemiologic study identified the
link between cancer and smoking, and the Nazi Party was the
first political entity to ban smoking in public places [Proctor,
1999].
TWO REMARKABLE ETHICAL GUIDELINES FORHUMAN RESEARCH IN GERMANY
In 1892, public outcry about an experiment in which prostitutes
and orphans were deliberately infected with syphilis to test new
treatments for the disease [Lignon et al., 2005] led to a Directive by
the Prussian Minister of Religious, Educational, and Medical
Affairs in 1900. It was probably the first document about the ethics
of human experimentation that specifically recognized the need (1)
to protect minors and those who are incompetent; (2) to explain
possible adverse consequences of the research; (3) to require
unequivocal consent; (4) to be carried out only by the director of
a medical institute or by another physician under his direct
supervision; and (5) to keep a medical record book that demon-
strates in writing how the requirements for human experimentation
were met [Grodin, 1992].
Regulations for informed consent for new medical procedures
were set forth in Germany in 1931 by the Reich Minister of
the Interior 2 years before Hitler’s rise to power. The raison
d’etre was the death of 75 children caused by an experimental
vaccine for tuberculosis administered by pediatricians in L€ubeck.
The guidelines—Regulations on New Therapy and Human
Experimentation—were issued on February 28, 1931
[International Digest of Health Legislation, 1980; Sass, 1983] and
the document appears in Box 1.
These regulations for informed consent are visionary in scope.
They require all physicians to (1) sign a commitment to the
guidelines; (2) to report any new treatment; its purpose; its justifi-
cation; how the procedure was carried out; and to indicate that
informed consent had been obtained; (3) to stress in academic
training courses the physician’s special role in novel treatment and
its scientific study; and (4) to protect the patient’s privacy in any
publication. To quote Grodin [1992], ‘‘In many ways, these guide-
lines are more extensive than either the Nuremberg Code or the later
Declaration of Helsinki.’’ It should be recognized that this is a
Box 2: Nuremberg Code* [1946]
(1) The voluntary consent of the human subject is absolutely essential.
This means that the person involved should have legal capacity to give consent; should be so situated as to be able to exercise free
power of choice without the intervention of any element of force, fraud, deceit, duress, over-reaching, or other ulterior form of
constraint or coercion; and should have sufficient knowledge and comprehension of the elements of the subject matter involved as
to enable him to make an understanding and enlightened decision. This latter element requires that before the acceptance of an
affirmative decision by the experimental subject there should be made known to him the nature, duration, and purpose of the
experiment; the method and means by which it is to be conducted; all inconveniences and hazards reasonably to be expected; and
the effects upon his health or person which may possibly come from his participation in the experiment.
The duty and responsibility for ascertaining the quality of the consent rests upon each individual who initiates, directs or engages
in the experiment. It is a personal duty and responsibility which may not be delegated to another with impunity.
(2) The experiment should be such as to yield fruitful results for the good of society, unprocurable by other methods or means of
study, and not random and unnecessary in nature.
(3) The experiment should be so designed and based on the results of animal experimentation and a knowledge of the natural history
of the disease or other problem under study that the anticipated results will justify the performance of the experiment.
(4) The experiment should be so conducted as to avoid all unnecessary physical and mental suffering and injury.
(5) No experiment should be conducted where there is an a priori reason to believe that death or disabling injury will occur; except,
perhaps, in those experiments where the experimental physicians also serve as subjects.
(6) The degree of risk taken should never exceed that determined by the humanitarian importance of the problem to be solved by the
experiment.
(7) Proper preparation should be made and adequate facilities provided to protect the experimental subject against even remote
possibilities of injury, disability, or death.
(8) The experiment should be conducted only by scientifically qualified persons. The highest degree of skill and care should be
required through all stages of the experiment of those who conduct or engage in the experiment.
(9) During the course of the experiment the human subject should be at liberty to bring the experiment to an end if he has reached the
physical or mental state where continuation of the experiment seems to him to be impossible.
(10) During the course of the experiment the scientist in charge must be prepared to terminate the experiment at any stage, if he has
probable cause to believe, in the exercise of the good faith, superior skill and careful judgment required of him that a continuation
of the experiment is likely to result in injury, disability, or death to the experimental subject.
*Nuremberg Code, 1946 is from ‘‘Permissible Medical Experiments.’’ Trials of War Criminals before the Nuremberg Military Tribunals under
Control Council Law No. 10: Nuremberg, October, 1946–April, 1949. Washington: U.S. Government Printing Office, Vol. 2, pp. 181–182.
COHEN JR. 689
statement by Michael Grodin, who is Professor of Health Law,
Bioethics, Human Rights, Socio-Medical Sciences and Psychiatry,
and also Director of the Bioethics and Human Rights Program at
Boston University.
Throughout the Nazi era, these regulations remained in place,
although they were ignored for some persons [Sass, 1983], partic-
ularly Jews, Gypsies, Slavs, prostitutes, criminals, vagrants, political
prisoners, homosexuals, psychiatric subjects, the mentally defi-
cient, the physically deformed, and those who opposed the Nazi
regime [Ernst, 2001; Geiderman, 2002; Sofair and Kaldjian, 2002].
Some authors have indicated that the Reich Guidelines were
valid and enforceable laws right up to 1945 [Sass, 1983; Fischer and
Breuer, 1989; Fluss and Grodin, 1992], whereas a few have claimed
that the Guidelines were only recommendations without legal
status [Howard-Jones, 1982].1
THE NUREMBERG CODE OF 1946
The Nuremberg Code of 1946 was a document delimiting permis-
sible medical experimentation on human subjects (Box 2). The
Tribunal for the Doctors’ Trial convened 139 times to consider the
evidence on 23 defendants. A great deal of evidence was amassed
about the medical atrocities committed by them, and the Nurem-
berg Code was useful in addressing their many failures in medical
ethics. By August 20, 1947, the death sentence was imposed on seven
doctors [Annas and Grodin, 1992].
The major architects of the Nuremberg Code were Leo Alexander
[1949] and Andrew Ivy, both of whom were medical experts at the
Nuremberg trial. They had read the works of Hippocrates (ca. 460
BCE—ca. 370 BCE), Percival (1803), Beaumont (1833), and
Bernard (1865). All of these deal with the physician’s responsibility
to benefit the patient.
Only Hippocrates is concerned with the relationship between
physician and patient. Percival addresses innovative therapy, and
the first American Medical Association Code of ethics in 1847 was
based on the work of Percival [Grodin, 1992]. Beaumont
covers non-therapeutic experimentation; and Bernard focuses on
scientific method and therapeutic research. In addition, both
Beaumont and Bernard are concerned with acceptable experimen-
tal risk, but only Beaumont discusses voluntary consent as being
necessary for human experimentation [Grodin, 1992]. Alexander
and Ivy were aware of at least some of the pre-war German literature
on the ethics of human experimentation; Alexander specifically
cited an early German book on the ethics of human experimenta-
tion: Der Arzt im Recht [Ebermayer, 1930].
TWO NOTES ABOUT THE NUREMBERG TRIALS
The small number of defendants during the Nuremberg Doctors’
Trial has been criticized for its narrow focus [Moreno, 2000]. Most
Nazi physicians who committed medical atrocities never came to
justice by courts of law, and in the post-World War II era, went on to
continue their professional lives (vide infra).
In 1946, the U.S. developed its own ethical standards for research
specifically to support the Nuremberg prosecutions, not because a
need was perceived for ethical guidance in America [Grodin, 1992].
In fact, these ethical standards were rushed into print 19 days after
the prosecution’s opening arguments were presented during the
trial [Grodin, 1992]. The Code was seen ‘‘as necessary for
barbarians, not for fine upstanding people.’’ This sense of ‘‘Nazi
exceptionalism’’ led to a very long delay in U.S. physicians taking
seriously the notion of informed consent [Faden et al., 1996; Wynia
and Wells, 2007].
AMERICAN MODELS FOR EARLY NAZI PROGRAMS:COMPULSORY STERILIZATION; MEDICALEXPERIMENTS ON PRISON INMATES; AND RACIALDISCRIMINATION
Some events that transpired in the United States served as models
for some of the early Nazi programs during their rise to power and,
in some instances, to justify some of their programs already
underway. These included sterilization of certain groups of people,
exploitation and abuse of prison inmates for medical experiments
dating from as early as 1906 (and continuing after the war until
1972), and by the well-documented discrimination against black
people. The German literature of that period, including the Archives
of Racial Hygiene and Social Biology, makes it abundantly clear that
the Nazis admired what the United States had accomplished
[Proctor, 1988; Lederer, 1995; Hornblum, 1997; Weyers, 1998;
Geiderman, 2002]. An important book by Baron [2007] is titled
The Anglo-American Biomedical Antecedents of Nazi Crimes.
SterilizationThe US was the first country in the world to undertake compulsory
sterilization for certain classes of people. Laws for sterilization were
drafted by physicians, and were upheld by the Supreme Court in
1927. Ironically, these laws were still valid in 19 states in 1985
[Baron, 1997]. The principal targets included those with mental
retardation, mental illness, epilepsy, blindness, deafness, physical
deformity, and Native Americans and criminals in prisons [Kevles,
1985]. More than 65,000 individuals were sterilized in 33 states that
had compulsory programs [Kevles, 1985; Carey, 1998; Baron,
2007].
Human Experimentation on PrisonersAmerican prisoners were cheap; they were available; they could be
coerced; and follow-up was easy. Medical researchers could offer
incentives to prisoners: cigarettes and cigars; money; reduction of
prison time; and for the more dangerous experiments, full pardon
[Hornblum, 1997; Lerner, 2007].
In 1906, an American physician, Richard P. Strong, infected
prisoners condemned to death with cholera serum in Bilibid
Prison in Manilla. Thirteen fatalities were eventually attributed to
a bottle of bubonic plague serum ‘‘substituted by mistake.’’ Later,
Strong became Professor of Tropical Medicine at Harvard Univer-
sity. After 6 years, his beriberi experiments also resulted in some
1I was unable to determine whether the Reich Guidelines were actually
used in 1931 and 1932, later during the Nazi era for the Volk (the German
people), and whether they were retrospectively and historically
considered to have been valid in East Germany.
690 AMERICAN JOURNAL OF MEDICAL GENETICS PART A
deaths, but survivors were ironically ‘‘rewarded’’ with cigarettes
and cigars [Strong, 1906; Taber, 1907; Pappworth, 1967; Cherin,
1989].
In 1915, Dr. Joseph Goldenberger, a Public Health Service
researcher, induced pellagra in healthy Mississippi prisoners,
who ‘‘signed up’’ for the experiment. The inmates experienced a
severe rash; diarrhea; lethargy; mental confusion; and pains in their
backs, sides, and legs [Etheridge, 1972; Lederer, 1995].
In 1918, Dr. L. L. Stanley, a resident physician at San Quentin
State Prison in California, transplanted testicles from recently
executed convicts into senile and devitalized men. By 1920, animal
glands were substituted and were grafted to the testes of the
prisoners [Hornblum, 1998].
Stanley indicated that the best glands to use were taken from
rams, goats, or boars between 12 and 18 months of age. Also,
hundreds of inmates were injected with animal testicular substan-
ces. Stanley was convinced that his procedures had a ‘‘decided
effect’’ from ‘‘general asthenia’’ to ‘‘renewed sexual stimulation.’’
Stanley called his operations ‘‘practically painless and harmless’’
and added that they could be carried out on prisoners because of
their regimented lifestyles [Hornblum, 1998]. He published his
experimental findings in Endocrinology [Stanley, 1922].
In 1934, Dr. H. J. Corper at Denver’s National Jewish Hospital
claimed that a tuberculosis vaccine that he had developed was ready
for trial on human beings. Two convicts from the Colorado
Penitentiary were selected for the clinical trial among the 800
prisoners who had applied because Governor Edwin C. Jones had
promised executive clemency for survivors of the risky experiment
[Hornblum, 1997].
By the summer of 1942, inmates in state penal systems were
involved in dangerous medical experiments, including injecting
blood from beef cattle as a new source of plasma; studies of atropine;
experimentation with sleeping sickness, sandfly fever, and dengue
fever; and exposure to gonorrhea and gas gangrene [United States
Department of Justice, 1944; O’Hara, 1948; Wharton, 1954].
Studies of malaria in over 400 prisoners were carried out at the
Stateville Penitentiary in Illinois between 1944 and 1946. One
inmate wrote that although they had to contend with periodic
mosquito bites, raging fevers, nausea, vomiting, blackouts, endless
untested medications, and occasional relapses, ‘‘no one squawked.
They all took it like men’’ [Leopold, 1958]. A New York Times
editorial stated, ‘‘these one-time enemies to society appreciate to
the fullest extent just how completely this is everybody’s war
[Laurence, 1945].
The medical experiments on prisoners continued during
the post-war period until 1972. Although they did not influence
the Nazis, these experiments by American physicians became
more extensive during this period of time than before and during
the war. To allow modern physicians to become familiar with these
unethical experiments in our own country, they are summarized
in Appendix I.
Discrimination Against Black People in theUnited StatesFor contrast of early Nazi policy with discrimination in the US
against black people, the Nuremberg Laws are briefly summarized.
The Nuremberg Laws signed by Hitler in 1935 (1) excluded Jews
from German citizenship, (2) prevented marriage and/or sexual
relations between Jews and non-Jews, and (3) defined those who
were 1/8 Jewish and in some cases 1/4 Jewish as legally Aryan who
could marry full-blooded Germans. In 1938, Jewish physicians were
barred from practicing medicine except on other Jews [Proctor,
1992].
In the United States, several southern states defined an individual
who was 1/32 black as still legally black. German medical journals
produced charts showing which states disallowed blacks from
marrying whites or from voting. In 1939, the Archives of Racial
Hygiene and Social Biology reported the refusal of the American
Medical Association to admit 5,000 black physicians to their ranks2
[Proctor, 1992].
TWO IRONIES IN US AND NAZI LAWS
(1) In 1933, Hermann G€oring banned vivisection of laboratory
animals ironically on the grounds that it was unethical [Proctor,
1999]. This became a Nazi law on November 24 of the same year
[Grodin, 1992]. If the Reich Guidelines Circular of 1931 (Box 1) had
any force in law, ‘‘the guidelines’ stipulation that animal experi-
mentation precede any human experimental trials would have been
revoked by this 1933 Nazi legislation. Ironically, if this law . . . (had
included human beings as animals) . . .most, if not, all Nazi human
experimentation would have been outlawed’’ [Grodin, 1992].
A parallel irony is found in some laws in the United States. The
Society for the Prevention of Cruelty to Animals became a law
earlier than any law to protect children. In fact, the first case brought
on behalf of a child on April 19, 1874 stated explicitly that the child,
as an animal, should be protected. The American Society for the
Prevention of Cruelty to Children was finally organized in Decem-
ber 1874 [Cone, 1979; Grodin, 1992].
(2) In Germany, Haeckel [1900] was the first to consider killing
‘‘weaklings’’ [Haeckel, 1900]. Binding and Hoche [1920] published
Release and Destruction of Lives Not Worth Living in which ‘‘the right
to live must be justified.’’ Certain individuals, such as the incurably
ill and institutionalized psychiatric patients, could have their lives
terminated, and this was claimed to be humane. These ideas, of
course, became incorporated into Nazi policy [Geiderman, 2002].
Examples of ‘‘lives not worth living’’ also appeared in the
American literature, although they never became widely accepted.
This idea received support from Carrel [1935], the French-
American Nobel Laureate, who strongly suggested that those in-
dividuals who were criminals or mentally ill should be ‘‘humanely
and economically disposed of in small euthanasia institutions
supplied with proper gasses.’’
Carrel also praised the Nazi regime:
The German government has taken energetic measures
against the propagation of the defective, the mentally dis-
eased, and the criminal. The ideal solution would be the
suppression of each of these individuals as soon as he has
proven himself to be dangerous [Reggiani, 2002; Baron,
2007].
2On July 10, 2008, JAMA finally issued an online apology by the AMA for
‘‘its past history of racial inequality towards African-American physicians.’’
COHEN JR. 691
Later, as German psychiatrists were sending the last of their
patients to the gas chambers, F. Kennedy [1942], in the Journal of the
American Psychiatric Association, called for the killing of children
with mental retardation, who he referred to as ‘‘nature’s mistakes.’’
American journals as diverse as the American Scholar and the
Journal of the American Institute of Homeopathy, among others,
debated using forced euthanasia until the reports of the Nazi
exterminations appeared in US newspapers [Proctor, 1992].
SOCIAL DARWINISM, RACIAL HYGIENE, ANDTHE NAZI DOCTORS
Charles Darwin’s epoch-making book Origin of Species was pub-
lished in 1859. Evolution took place by natural selection to ensure
that the ‘‘fittest’’ of species would survive. However, fitness was
relative to the ecological niche in which the organism evolved
[Darwin, 1859].
Social Darwinism was the notion that Charles Darwin’s biologi-
cal evolution through competition (survival of the ‘‘fittest’’) could
be applied to human individuals, groups, or nations. This concept
was derived from the work of Herbert Spencer’s book of 1864,
Principles of Biology [Spencer, 2002; updated version]; Thomas
Malthus’s An Essay on the Principles of Population [Malthus, 1798];
Charles Darwin’s cousin, Francis Galton, the founder of eugenics
[Forrest, 1974]; and others. Even before Darwin’s work, Arthur de
Gobineau wrote about racial superiority in An Essay on the Inequal-
ity of Human Races (1853–1855) [Biddiss, 1970]. In Germany, Ernst
Haeckel’s Riddle of the Universe first published in 1899 brought
Social Darwinism and racial hygiene to a very wide audience
[Haeckel, 1900].
The Social Darwinists in Germany were concerned with two
basic problems: (1) medical intervention had allowed the weak to
survive and reproduce, which confounded natural selection and (2)
‘‘weak and inferior races’’ were reproducing faster than the
‘‘German race,’’ and this was considered to be particularly harmful
since ethnic Germans were experiencing a falling birth rate
[Geiderman, 2002].
In 1879, as a youth, Alfred Ploetz, a German physician, biologist,
and eugenicist, founded a secret schoolboy society for the improve-
ment of the human race. He first proposed the theory of racial
hygiene in 1895 [Ploetz, 1895]. He founded the periodical Archives
for Racial and Social Biology in 1904. Also, Ploetz together with Ernst
Rudin, a psychiatrist, founded the Society for Racial Hygiene in
1905 [Kater, 1989].
Ploetz, who thought the white race was superior and the German
people were at the top, suggested that during a war, only inferior
members of a race should be sent to the front to serve as ‘‘cannon
fodder.’’ He even thought that to keep a superior race healthy, a
group of doctors should decide whether an infant should be allowed
to live [Kater, 1989].
Ploetz was given an honorary doctorate from Munich University
in 1930, and 6 years later, Hitler personally appointed him as
Professor there [Kater, 1989].
Fritz Lenz, a pupil of Alfred Ploetz, was the Chief Editor of the
Archives for Racial and Social Biology from 1913 to 1933. In 1923, he
became the First Chair in Eugenics at Munich University. In 1933,
he established the first department of eugenics at the Kaiser
Wilhelm Institute of Anthropology, Human Heredity, and Eugen-
ics in Berlin. Lenz together with Bauer and Fischer summarized all
their research in Human Hereditary Theory and Racial Hygiene in
1936. Lenz3 and coworkers were considered to be Germany’s
leading racial theorists. Lenz praised Hitler as the first great politi-
cian to adopt racial hygiene as a state policy. It was Lenz [1931] too
who coined the phrase applied biology, which Nazi leaders used
when they referred to National Socialism as applied biology
[Proctor, 1992]. Lenz’s idea that the superiority of the ‘‘Nordic
Race’’ was under threat made a strong impression on Hitler [Kater,
1989].
German university institutes for racial hygiene (about 20 in
number) were established before the Nazis rose to power. The
largest such institution was Verschuer’s Frankfurt Institute for
Racial Hygiene, where Josef Mengele did his doctoral research on
the genetics of cleft palate [Proctor, 1992].
The idea of biological determinism attracted German physicians
to join the Nazi party. By 1929, 6% of all doctors joined the National
Socialistic Physicians’ League. By 1937, doctors were members of
the SS with seven times the frequency of other employed male
groups in the population. By 1942, half of all German doctors had
joined the Nazi party, and many had roles in the Nazi government
and in the universities [Kater, 1983, 1989; Cohen, 1988; Proctor,
1992].
The medical profession, particularly psychiatrists and university
physicians, played key roles in sterilization, cruel medical experi-
ments, selecting those to be murdered, and the exploitation of dead
bodies. The Action T4 Program between 1939 and 1941 led to the
systematic killing of ‘‘lives not worth living.’’ Later, during the
‘‘final solution’’ for Jewish victims, ‘‘selection’’ for death was
performed by SS doctors who had gained ‘‘experience’’ earlier by
making medical decisions in the Action T4 Program. Physicians
also determined the modes of death.4 The gas chamber, for example,
clearly developed from Nazi medicine [Mitscherlich and Mielke,
1949; Lifton, 1986; Proctor, 1988, 1992; Wild, 1988; Kater, 1989;
Gallaher, 1995; M€uller-Hill, 1998; Hoedeman, 1991; Breggin, 1993;
Friedlander, 1995; Ernst, 2001; Dudley and Gale, 2002; Seeman,
2005; Seidelman, 2007].
NAZI PERSECUTION OF JEWISH PHYSICIANS
Hitler spoke of the German people as biological corpus
(Volksk€orper), which was diseased because of the Jew, who is a
‘‘bacillus’’ or ‘‘parasite’’ engaging in ‘‘blood poisoning’’ inside the
German national body. He lamented that the ‘‘Jewish poison’’ had
been able to ‘‘penetrate the bloodstream’’ of the German people
3In marked contrast, his son Widukind Lenz was a humanitarian and
distinguished physician geneticist, who delineated many newly
recognized disorders (Lenz microphthalmia syndrome, Cenari–Lenz
syndrome, femur-fibula-ulna dysostosis, and caudal deficiency complex,
to name a few). He was the first to recognize the thalidomide disaster and
became an authority on limb malformations. He published extensively
and had widely diversified interests, including, among others, growth and
development, nutrition, sex determination, and gonadal function [Opitz
and Wiedemann, 1996].4With the exception of death by machine gun or by hanging.
692 AMERICAN JOURNAL OF MEDICAL GENETICS PART A
earlier because the state had no power to master the ‘‘disease’’
[Kater, 1989].
This imagery of Jews became part of the mainstream thinking of
the Nazi Physicians’ League, in which ‘‘cleansing of v€olkisch body’’
from Jews was bandied about. The anti-Jewish race laws were
introduced in 1935 [Kater, 1989]. The Nazis continued their
medicalized war against the Jews. Physicians who were Jewish were
forbidden from practicing on non-Jews, and were dismissed from
university posts, particularly professorships, as well as from other
facets of health leadership and from medical societies. In the ‘‘final
solution,’’ massive genocide of 6 million Jews took place in con-
centration camps during the Holocaust. Three Nazi medical images
had converged by that time: the Jew as ‘‘disease,’’ the German
people as the ‘‘patient,’’ and National Socialism as the ‘‘physician’’
[Kater, 1989]. Jewish pediatricians and dermatologists, who made
up a significant proportion of both medical specialties (49% of all
pediatricians, n¼ 1,253, and 32% of these were women [Seidler,
2000]; 27.4% of all dermatologists, n¼ 2,078 [Sholz and Eppinger,
1999]) experienced the worst kind of persecution.
PSEUDO-GENETICS AND THE NAZI PHYSICIANS
In 1933, the Nazi’s implemented their Law for the Prevention of
Hereditarily Diseased Descendents. This law permitted the involun-
tary sterilization of those thought to be carrying diseases of genetic
origin [Proctor, 1988; Hanauske-Abel, 1996]. The purpose was to
‘‘cleanse’’ the gene pool and improve the ‘‘German race.’’ Although
those with ‘‘congenital feeblemindedness’’ and schizophrenia made
up the majority of targeted individuals, the law also applied to those
with manic depressive psychosis, idiopathic epilepsy, Huntington
disease, major malformations, congenital blindness, congenital
severe hearing deficit, and chronic alcoholism. The law was
later expanded to include ‘‘dangerous habitual criminals and
allowed for the involuntary abortion of a fetus during the first
6 months of pregnancy carried by a mother with ‘‘hereditary illness’’
[Geiderman, 2002].
The law resulted in the sterilization of about 400,000 individuals.
Some 200 ‘‘Genetic Health Courts’’ were set up in which a jury of
‘‘experts’’ determined who should be sterilized [Rothmaler, 1989;
Ernst, 2001]. Men underwent vasectomy and women underwent
tubal ligation or exposure to radiation. Most were Germans rather
than Jews or other non-Aryan peoples [Proctor, 1988; Barondess,
1996; Weyers, 1998].
The Law for the Protection of the Genetic Health of the German
People required premarital medical examinations to ‘‘prevent the
spread of racially damaging diseases’’ and the Law for the Protection
of German Blood and German Honor forbade marriage or sexual
relations between Jews and non-Jews and defined what percentage
of Jewish ancestry was permissible [Proctor, 1988; Weindling, 1989,
2005].
Physicians were required to receive training in ‘‘genetic
pathology’’ at the racial institutes. They became state spies who
were to report patients who were potential candidates for
sterilization [Seidelman, 1996]. In 1933, Deutsches Artzeblatt pub-
lished an article titled The Physician and Genetic Improvement and
introduced the concept of the extermination of a ‘‘life not worth
living’’ [Lommel, 1933].
NAZI PHYSICIANS WHO COMMITTED ATROCITIES ANDEPONYMS OF UNETHICAL GERMAN PHYSICIANS
Table I lists some important Nazi physicians who committed
atrocities. These Nazi physicians and those who were tried at
Nuremberg represent only the tip of the iceberg. In 1949, Mit-
scherlich and Mielke estimated that about 350 doctors behaved
criminally, but from more recent data, Ernst [2001] has indicated
that this figure represents a gross underestimate. Table II lists some
eponyms of unethical German physicians with recommended
changes in the names of the disorders [Strous and Edelman, 2007].
Some of these physicians were Professor Doctors. These include
Professor Dr Hans Eppinger (Table II), Professor Dr Julius
Hallervorden (Table II), Professor Dr August Hirt (Table I),
Professor Dr Jussuf Ibrahim (Table II), Professor Dr Eduard
Pernkopf (Table II), Professor Dr Hans Conrad Julius Reiter
(Table II), Professor Dr Ernst Rudin (Table I), Professor Dr Karl
Schneider (Table I), Professor Dr Hugo Spatz (Table II), Professor
Dr Hermann Stieve (Table I), Professor Dr Walter Stoeckel
(Table II), Professor Dr Otmar von Verschuer (Table I), and
Professor Dr Hermann Voss (Table I).
Except for the suicides of Eppinger, Hirt, and Schneider, the
other Professor Doctors listed in Tables I and II, despite the
atrocities they committed during the Third Reich, were never
prosecuted, and went on to continue their professional lives after
the war. They are discussed below except for Julius Hallervorden
and Eduard Pernkopf, whose criminal behavior was so heinous as to
warrant separate sections (Boxes 3 and 4).
Ibrahim, a pediatrician, was honored after World War II with the
Ibrahim Clinic for Child and Adolescent Medicine (Kinderklinik
Jussuf Ibrahim) at the Friederich–Schiller–Universit€at in Jena; two
Ibrahim kindergartens; and one Ibrahim Street. An investigative
commission concluded that Ibrahim had not only supported the
Nazi euthanasia project but also played an active role in the killing of
severely sick and handicapped children. His name was removed
following a public outcry [Reif-Spirek, 2001].
Despite Reiter’s dedicated support of Hitler’s policies, his fanat-
ical university teaching of racial hygiene, his appointment as
Director of the Health Department in the State of Mecklenburg-
Schwerin, and his authorization of experimental atrocities in
concentration camp inmates, he was awarded a number of inter-
national honors after the war, including being a corresponding
member of the Royal Society of Medicine in London [Panush
et al., 2003; Lu and Katz, 2005]. In 2003, an international
group of editors of rheumatology journals made the decision not
to permit Reiter’s name in any of the disorders previously named
after him to be used in their journals [Dendl et al., 2004] (see
Table II).
Rudin, a cofounder of the Society for Racial Hygiene, was an
intellectual leader of the Nazi program of enforced eugenic sterili-
zation and was honored twice by Hitler for his contributions. He
was the President of the German Society for Psychiatrists and
Neurologists from 1935 to 1945. His colleagues nicknamed him
Reichsf€uhrer for Sterilization. Rudin neither fled nor hid at the end of
the war, but simply claimed that he was only a nominal member of
the Nazi Party, not a major architect of the Nazi sterilization
program, and he was completely exonerated (vide infra). His work
COHEN JR. 693
TAB
LEI.
Som
eIm
port
ant
Naz
iPh
ysic
ian
sW
hoCo
mm
itte
dAt
roci
ties
Nam
esLi
fesp
anPo
st-w
ardi
spos
itio
nAt
roci
ties
com
mit
ted
Augu
stH
irt
18
98–
19
45
Suic
ide
Prof
esso
rof
Anat
omy,
Stra
sbou
rgM
edic
alSc
hoo
l.Co
-inve
nto
rof
the
fluo
resc
ent
mic
rosc
ope.
Hir
tw
ante
dto
colle
ctsk
ulls
ofal
lra
ces
and
peop
lefo
rhi
sde
part
men
t.N
azi
auth
orit
ies,
inco
oper
atin
gw
ith
him
,ga
ssed
abou
t8
6Je
wis
hp
riso
ner
sfr
omco
nce
ntr
atio
nca
mp
san
dtr
ansf
erre
dth
ebo
dies
toh
isd
epar
tmen
t.H
irt
was
also
invo
lved
inex
peri
men
tal
atro
citi
esw
ith
mu
star
dga
san
dp
hos
gen
eJo
han
nPa
ulK
rem
er1
88
3–
19
65
He
was
con
vict
edat
the
Ausc
hwit
ztr
ial
and
sen
ten
ced
tode
ath,
but
this
was
late
rco
mm
uted
tolif
eim
pris
onm
ent.
He
was
rele
ased
in1
95
8an
ddi
edin
19
65
Serv
edin
the
SSas
aph
ysi
cian
inAu
sch
wit
z.P
arti
cip
ated
inth
ese
lect
ion
sfo
rga
ssin
gon
atle
ast
14
occa
sion
s.H
ew
aslik
ely
invo
lved
inth
ede
aths
ofse
vera
lth
ousa
nd
pri
son
ers.
He
was
also
inte
rest
edin
the
impa
cton
the
inte
rnal
orga
ns
resu
ltin
gfr
omst
arva
tion
ofp
riso
ner
s.H
eki
lled
such
pris
oner
sw
ith
ph
enol
inje
ctio
ns
afte
rw
hic
hhi
stop
atho
logi
cal
slid
esw
ere
mad
eof
the
liver
,sp
leen
,an
dpa
ncr
eas
for
his
stud
ySi
gmun
dR
asch
er1
90
9–
19
45
For
illeg
alad
opti
onan
dre
gist
rati
onof
two
boys
,R
asch
eran
dhi
sw
ifew
ere
arre
sted
,an
dR
asch
erw
asex
ecut
edat
Dac
hau
just
befo
relib
erat
ion
a
Carr
ied
out
term
inal
expe
rim
ents
onp
riso
ner
sin
spec
ial
pre
ssu
rech
ambe
rsto
help
deve
lop
met
hod
sto
dea
lw
ith
the
pro
ble
ms
ofh
igh
alti
tude
flyi
ng.
This
rese
arch
was
join
tly
spon
sore
db
yth
eLu
ftw
affe
and
the
SS.
Ras
cher
cau
sed
the
dea
thof
abou
t1
00
pri
son
ers.
He
was
also
invo
lved
infr
eezi
ng
exp
erim
ents
that
cau
sed
the
dea
ths
ofab
out
90
pris
oner
san
dex
trem
ep
ain
toab
out
20
0ot
her
sat
Dac
hau
con
cen
trat
ion
cam
pEr
nst
Ru
din
18
74–
19
52
Nev
erpr
osec
uted
Dir
ecto
rof
the
Kai
ser-
Wilh
elm
Inst
itu
teof
Psy
chia
try
inM
un
chen
.M
ajor
lead
erof
the
Naz
ieu
gen
ics
pro
gram
and
was
the
pri
nci
pal
arch
itec
tof
the
enfo
rced
prog
ram
ofst
erili
zati
on.
He
was
Pre
sid
ent
ofth
eG
erm
anSo
ciet
yof
Psyc
hia
tris
tsan
dN
euro
logi
sts
from
19
35
to1
94
5.
Ru
din
’sw
ork
onth
ege
net
ics
ofsc
hiz
oph
ren
iaco
nti
nu
esto
beci
ted
inth
efi
eld
ofp
sych
iatr
icge
net
ics
wit
hou
tre
fere
nce
tohi
sm
ajor
role
inth
eeu
gen
ics
ster
iliza
tion
pro
gram
inN
azi
Ger
man
yK
arl
Schn
eide
r1
89
1–
19
46
Com
mit
ted
suic
ide
in1
94
6Pr
ofes
sor
and
Chai
rman
ofth
eP
sych
iatr
yD
epar
tmen
tat
the
Un
iver
sity
ofH
eide
lber
g.H
est
udie
dvi
ctim
sof
euth
anas
iaw
hile
they
wer
est
illal
ive
and
diss
ecte
dth
eir
bra
ins
afte
rth
eyw
ere
mu
rder
edH
erm
ann
Stie
ve1
88
6–
19
52
Afte
rth
ew
ar,
Stie
vese
rved
asD
ean
ofth
eFa
cult
yof
Med
icin
eof
Hum
bolt
Un
iver
sity
,th
esu
cces
sor
toth
eU
niv
ersi
tyof
Ber
lin
Prof
esso
rof
Anat
omy
atth
eU
niv
ersi
tyof
Ber
lin.
Wh
enw
omen
wer
eto
beex
ecut
edby
the
Ges
tap
o,St
ieve
was
info
rmed
ofth
eir
date
sof
exec
utio
nin
adva
nce
and
the
wom
enw
ere
also
info
rmed
ofth
eda
tes
ofth
eir
deat
hs.
Stie
vew
ould
then
stu
dy
the
effe
cts
ofth
eps
ychi
ctr
aum
aon
the
thei
rm
enst
rual
pat
tern
s.Fo
llow
ing
thei
rex
ecut
ion
s,St
ieve
wou
ldd
isse
ctou
tth
eir
pel
vic
orga
ns
for
hist
olog
ical
exam
inat
ion
and
he
pu
blis
hed
thes
est
ud
ies.
Bot
ha
lect
ure
room
and
asc
ulp
ted
bu
stw
ere
ded
icat
edto
his
hon
orat
the
Ber
linCh
arit
eH
osp
ital
[Sei
del
man
,2
00
7]
Otm
arvo
nVe
rsch
uer
18
96–
19
69
Bec
ame
Prof
esso
ran
dH
ead
ofG
enet
ics
atth
eU
niv
ersi
tyof
Mu
nst
er,
whe
rehe
trai
ned
man
ypo
st-w
arG
erm
anle
ader
sin
the
fiel
dof
gen
etic
s
Dir
ecto
rof
the
Un
iver
sity
Inst
itu
teof
Gen
etic
sat
the
Un
iver
sity
ofFr
ankf
urt
and
the
Kai
ser-
Wilh
elm
Inst
itu
teof
Anth
rop
olog
yof
Ber
lin-D
ahle
m.
He
was
anex
per
ton
twin
stu
die
san
dw
asth
epr
inci
pal
inve
stig
ator
inth
eex
per
imen
tsof
Jose
ph
Men
gele
inAu
schw
itz
(Con
tinu
ed)
694 AMERICAN JOURNAL OF MEDICAL GENETICS PART A
on the genetics of schizophrenia is often cited without any reference
to his being a major architect of the Nazi sterilization program
[Stern, 1951; Seidelman, 1996].
Franz Kallmann (Kallmann syndromes 1, 2, 3, and 4)5 was a
German psychiatrist and geneticist, who moved to the United States
in 1936 and continued his career, writing a large number of articles.
He was discussed in a favorable light in the US, where he was said to
be strongly opposed to forced eugenic measures and had vocally
expressed this. He was said to have been banned from publishing or
speaking at medical meetings in Nazi Germany. In the United
States, he became one of the founders of psychiatric genetics
and was a leader in the studies of schizophrenia and other
disorders [Gershon and M€uller-Hill, 1989; Rainer, 1989]. A sym-
pathetic biographical sketch also appeared [Beighton and Beighton,
1997].
Kallmann was born into a Jewish family, although his father had
converted to Christianity. Kallmann’s wife Helly was Lutheran, and
her sister, an ardent Nazi functionary, advised Helly, in 1936, to
divorce Kallmann or failing that, they should flee Germany together
for another country, such as the United States. Although Kallmann
left because he was of Jewish heritage, more recent articles
[Abdullah, 2001; Mildenberger, 2002] have shown that he had an
unsavory past in Nazi Germany. He and von Verschuer (vide infra)
made up the powerful inner circle of Ernst Rudin, the cofounder of
the Society for Racial Hygiene and the Reichsf€uhrer for Sterilization
(vide supra).
In 1935, Kallmann presented an article at the International
Congress for Population Science in Berlin hosted by Hitler’s
Interior Ministry. He proposed an even more radical sterilization
policy than the Nazis had by arguing for the sterilization
of apparently healthy relatives of schizophrenics as well as the
schizophrenics themselves to eliminate all the defective genes.
Kallmann’s article was well received and highly acclaimed. In fact,
his genetic studies were used partly to justify the murder of
psychiatric patients, including many children [Mildenberger,
2002].
It was Rudin who orchestrated Kallmann’s move to the
United States, where Kallmann was reported to have commented,
‘‘Schizophrenics. . . (are) . . . a source of maladjusted and criminal
offenders . . . I am reluctant to admit the necessity of different
eugenic programs for democratic and fascistic communities . . .There are neither biological nor sociological differences between
a democratic and totalitarian schizophrenic’’ [Abdullah, 2001].
After his immigration to the US, Rudin’s assistant Theobald Lang
delivered Kallmann’s German data to him. His genetic studies based
on these data together with new studies in the United States were
published simultaneously in the US and Nazi Germany in 1938. In
this work, Kallmann thanked Rudin. At the end of the war,
Kallmann certified that Rudin was only a nominal member of the
Nazi Party and was not involved in any criminal activities, which
resulted in Rudin’s complete exoneration (vide supra) [Abdullah,
2001; Mildenberger, 2002].
Spatz, who researched the brains of children killed by
euthanasia, was arrested but never charged. In fact, he was invited
to join the U.S. Aeromedical Center in Heidelberg, where he
TAB
LEI.
(Con
tin
ued)
Nam
esLi
fesp
anPo
st-w
ardi
spos
itio
nAt
roci
ties
com
mit
ted
Her
man
nVo
ss1
89
4–
19
87
Voss
con
tin
ued
his
care
eraf
ter
the
war
.H
eha
dap
poin
tmen
tsat
Hal
le,
Jen
a,an
dsu
bseq
uen
tly
asPr
ofes
sor
Emer
itus
atth
eG
reifs
wal
dAn
atom
ical
Inst
itut
e
Prof
esso
rof
Anat
omy
and
Dea
nof
Med
icin
eof
Rei
chsu
niv
ersi
t€ at
ofPo
zen
.Fo
llow
ing
the
deat
hof
Pol
es,
they
wer
eei
ther
crem
ated
inth
eov
ens
ofhi
sin
stit
ute
ord
isse
cted
inh
isan
atom
yla
bor
ator
y.
He
used
the
bodi
esof
exec
ute
dp
riso
ner
sfo
rth
ep
rep
arat
ion
ofsk
elet
ons,
whi
chhe
sold
for
pro
fit.
Voss
also
pre
par
edd
eath
mas
ksan
dbu
sts
from
the
bod
ies
ofJe
ws
from
an
earb
yco
nce
ntr
atio
nca
mp.
Thes
ew
ere
then
sold
toth
eU
niv
ersi
tyof
Vien
na
Mus
eum
ofN
atu
ral
His
tory
,to
geth
erw
ith
the
sku
llsof
Jew
san
dn
on-J
ewis
hP
oles
.Th
esk
ulls
,m
asks
,an
db
ust
sw
ere
disp
laye
din
the
Mus
eum
’sR
ace
Gal
lery
.Vo
ssal
soco
auth
ored
ate
xtbo
okof
anat
omy
Tasc
hen
bu
chd
eAn
atom
ie.
Itw
asp
rob
ably
the
mos
tpo
pula
ran
atom
icte
xtb
ook
ever
pu
blis
hed
inG
erm
any
.Th
ere
wer
e1
7G
erm
anla
ngu
age
edit
ion
s,an
dSp
anis
han
dP
olis
hed
itio
ns
asw
ell
[Sei
delm
an,
20
07
]B
ased
onda
tafr
omLa
chm
an[1
97
7],
Kat
er[1
98
9],
Kas
ten
[19
91
],Al
y[1
99
4],
Seid
elm
an[1
99
6,
20
01
,2
00
7].
aR
ashe
r’sw
ifeco
uld
not
have
child
ren
and
Ras
her
knew
that
asu
cces
sful
SSca
reer
depe
nde
don
mal
epr
ogen
y,bu
tth
etw
obo
ysha
dbe
enill
egal
lyab
duct
ed.
Ras
her
was
arre
sted
and
late
rsh
otby
Him
mle
r’sm
enfo
rth
eab
duct
ion
[Kat
er,
19
89
].
5See OMIM [2008] in reference section.
COHEN JR. 695
TAB
LEII
.Ep
onym
sof
Un
ethi
cal
Ger
man
Phys
icia
ns
and
Rec
omm
ende
dCh
ange
s*
Nam
esEp
onym
sR
ecom
men
ded
chan
ges
Un
ethi
cal
beha
vior
Juliu
sH
alle
rvor
den
(18
82–
19
65
)H
alle
rvor
den–
Spat
zsy
ndr
ome
PKAN
neu
roax
onal
dyst
roph
yH
alle
rvor
den
asP
rofe
ssor
and
Hea
dof
Neu
rop
ath
olog
yat
the
Kai
ser
Wilh
elm
Inst
itu
tefo
rB
rain
Res
earc
hac
qu
ired
69
7b
rain
sfr
omvi
ctim
sof
invo
lun
tary
med
ical
killi
ng
(‘‘e
uth
anas
ia’’)
.H
eis
said
toha
veb
een
pre
sen
tat
the
killi
ng
ofm
ore
than
60
child
ren
and
adol
esce
nts
atth
eB
ran
den
ber
gP
sych
iatr
icIn
stit
ute
.Fo
rde
tails
,se
eB
oxIII
Hug
oSp
atz
(18
88–
19
69
)Sp
atz–
Stie
fler
reac
tion
Para
lysi
sag
itan
sSp
atz
asD
irec
tor
ofth
eK
aise
rW
ilhel
mIn
stit
ute
wor
ked
wit
hH
alle
rvor
den
and
did
rese
arch
onch
ildre
nki
lled
inth
e‘‘e
utha
nas
ia’’
pro
ject
.H
eal
soob
tain
edh
un
dre
ds
ofb
rain
sfr
omm
enta
llyill
pat
ien
tski
lled
atth
eB
ran
den
bu
rgP
sych
iatr
icIn
stit
ute
Han
sEp
pin
ger
(18
79–
19
46
)Ca
ucho
is–
Eppi
nge
r–Fr
ugon
isy
ndr
ome
Eppi
nge
rsp
ider
nev
us
Port
alve
inth
rom
bosi
s
Spid
ern
evus
Eppi
nge
rw
asP
rofe
ssor
ofa
pro
min
ent
inte
rnal
med
icin
ecl
inic
inVi
enn
a.H
eco
nd
uct
edcr
uel
exp
erim
ents
onG
ypsy
pris
oner
sw
ho
wer
efo
rced
tod
rin
kse
aw
ater
Mur
adJu
ssuf
Bey
Ibra
him
(18
77–
19
52
)B
eck–
Ibra
him
dis
ease
Con
gen
ital
cuta
neo
usca
ndi
dias
isIb
rahi
mw
asan
Egy
pti
anp
edia
tric
ian
wh
oco
mp
lete
dh
isst
udie
sin
Ber
linan
dw
asla
ter
app
oin
ted
asP
rofe
ssor
ofPe
diat
rics
.H
esu
pp
orte
dth
eN
azi
killi
ng
pro
gram
(‘‘e
uth
anas
ia’’)
and
was
thou
ght
toh
ave
take
nan
acti
vero
lein
killi
ng
sick
and
men
tally
illch
ildre
n,
wh
oh
adb
een
defi
ned
by
the
Naz
isas
‘‘un
wor
thy
life’
’Fr
iedr
ich
Weg
ener
(19
07–
19
90
)W
egen
ergr
anul
omat
osis
Idio
path
icn
ecro
tizi
ng
gran
ulom
atos
isW
egen
erw
asa
pat
hol
ogis
tw
ho
was
ad
edic
ated
Naz
iev
enbe
fore
Hit
ler
cam
eto
pow
er.
Un
der
Hit
ler,
he
bec
ame
alie
uten
ant
colo
nel
.H
eis
thou
ght
toh
ave
bee
nin
volv
edin
the
atro
citi
esat
the
Lod
zgh
etto
,w
her
eh
ew
asst
atio
ned
Han
sCo
nra
dJu
lius
Rei
ter
(18
81–
19
69
)R
eite
rsy
ndr
ome
Rei
ter
spir
oche
te
Rei
ter
test
Infe
ctio
usur
oart
hrit
isA
trep
onen
eva
rian
t,on
ceca
lled
Trep
onem
afo
ran
sCo
mpl
emen
tfi
xati
onte
stfo
rsy
phili
s
Rei
ter
was
aG
erm
anb
acte
riol
ogis
tw
ho
join
edth
eN
azi
par
tyin
19
32
and
emb
race
dH
itle
r’sd
octr
ines
.H
eb
ecam
eD
epar
tmen
tD
irec
tor
ofth
eK
aise
rW
ilhel
mIn
stit
ute
ofEx
peri
men
tal
Ther
apy
inB
erlin
and
was
late
rap
poi
nte
dD
irec
tor
ofth
eH
ealt
hD
epar
tmen
tof
the
Stat
eof
Mec
klen
burg
-Sch
wer
in.
Thro
ugh
out
his
care
er,
he
enco
urag
edth
efa
nat
ical
teac
hin
gof
raci
alh
ygi
ene
inun
iver
siti
es.
AsD
irec
tor,
he
dev
ised
,ap
pro
ved
,an
dsu
perv
ised
med
ical
exp
erim
ents
onvi
ctim
sin
con
cen
trat
ion
cam
ps,
incl
ud
ing
one
inw
hic
h2
50
Bu
chen
wal
dp
riso
ner
sdi
edof
typh
us
inoc
ula
tion
s
(Con
tinu
ed)
696 AMERICAN JOURNAL OF MEDICAL GENETICS PART A
TAB
LEII
.(C
onti
nue
d)
Nam
esEp
onym
sR
ecom
men
ded
chan
ges
Un
ethi
cal
beha
vior
Han
sJo
achi
mSc
here
r(1
90
6–
19
45
)Va
nB
ogae
rt–
Sche
rer–
Epst
ein
syn
drom
eCe
rebr
oten
din
ous
xan
thom
atos
isSc
here
rw
asa
Ger
man
neu
rop
ath
olog
ist
wh
ow
asth
efi
rst
phys
icia
nto
clea
rly
dis
tin
guis
hp
rim
ary
and
seco
nd
ary
glio
blas
tom
as.
Wor
kin
gin
the
Neu
rolo
gyIn
stit
ute
ofB
resl
au,
hew
asd
irec
tly
invo
lved
inth
en
euro
pat
hol
ogic
stud
yof
over
30
0P
olis
han
dG
erm
anch
ildre
nki
lled
(‘‘e
utha
niz
ed’’)
atth
en
earb
yLo
ben
Psy
chia
tric
Clin
icfo
rYo
uth
Wal
ter
Stoe
ckel
(18
71–
19
61
)St
oeck
elop
erat
ion
Scha
uta–
Stoe
ckel
oper
atio
nK
elly
–St
oeck
elsu
ture
Pubo
vagi
nal
fasc
ial
slin
gop
erat
ion
for
stre
ssin
con
tin
ence
Rad
ical
vagi
nal
hyst
erec
tom
yw
ith
lym
phad
enop
athy
Ante
rior
colp
orrh
aphy
Inte
rnat
ion
ally
ren
own
edG
erm
angy
nec
olog
ist
wh
ow
asPr
ofes
sor
ofG
yn
ecol
ogy
atth
eB
erlin
Char
ity
Hos
pit
al.
He
was
very
sym
pat
het
icto
Naz
ica
use
s.To
geth
erw
ith
oth
erG
erm
angy
nec
olog
ists
,h
ese
nt
Hit
ler
ate
legr
amof
enth
usi
asti
csu
ppor
t.As
Pre
sid
ent
ofth
eG
erm
anSo
ciet
yof
Gy
nec
olog
y,
hew
asw
ith
asi
ngl
eex
cep
tion
resp
onsi
ble
for
the
exp
uls
ion
ofal
lJe
wis
hp
hy
sici
ans
from
the
Soci
ety
Edua
rdPe
rnko
pf(1
88
8–
19
55
)Pe
rnko
pfAt
las
ofH
uman
Anat
omy
See
Box
4on
Pern
kopf
Perk
opf
was
Prof
esso
rof
Anat
omy
and
Dea
nof
Med
icin
eat
the
The
Un
iver
sity
ofVi
enn
a.H
ejo
ined
the
Naz
iP
arty
in1
93
3.
He
was
the
maj
orin
stig
ator
inp
urg
ing
Jew
ish
phys
icia
ns
from
the
med
ical
sch
ool:
15
3Je
wis
hfa
cult
ym
embe
rs,
incl
ud
ing
thre
eN
obel
Lau
reat
es.
Per
nko
pf
wro
tea
mon
umen
tal
and
still
use
dan
atom
ical
atla
s,in
wh
ich
the
anat
omic
ald
raw
ings
wer
esi
gned
wit
hsw
asti
kas.
Ath
isAn
atom
ical
Inst
itu
te,
he
rece
ived
alm
ost
1,4
00
bod
ies
from
Ges
tapo
exec
uti
onch
amb
ers
inVi
enn
a.Fo
rd
etai
ls,
see
Box
4D
ata
from
Shaf
er[1
97
7],
Har
per
[19
96
],Is
rael
[19
98
],W
alla
cean
dW
eism
an[2
00
0],
Shev
ell
and
Peiff
er[2
00
1],
Pan
ush
etal
.[2
00
3],
Luan
dK
atz
[20
05
],W
ayw
odt
etal
.[2
00
6],
Stro
usan
dEd
elm
an[2
00
7],
OM
IM2
34
20
0[2
00
8].
*Kal
lman
nsy
ndr
omes
1,
2,
3,
and
4do
not
appe
arin
this
tabl
e.Se
ete
xtfo
rFr
anz
Kal
lman
n’s
unsa
vory
past
inN
azi
Ger
man
y.I
invi
tem
edic
alge
net
icis
tsto
give
me
thei
rre
com
men
dati
ons
abou
tw
heth
eran
epon
ymou
sch
ange
isre
com
men
ded
.
COHEN JR. 697
continued to do research. In 1949, Spatz was given laboratories
in the Physiological Institute in Giessen and later transferred
to the new Max Planck Institute in Frankfurt [Strous and Edelman,
2007].
Stoeckel, an internationally known gynecologist and obstetri-
cian, was an ardent supporter of Hitler, and together with other
German gynecologists sent Hitler a telegram, expressing their
‘‘enthusiastic admiration.’’ He served as President of the German
Society of Gynecology from 1933 to 1934 and was responsible
for the expulsion of Jewish physicians from the society. He died in
1961 [Strous and Edelman, 2007].
EPONYMS OF FAMOUS PHYSICIANS WHO WERENAZI VICTIMS
Table III lists the eponyms of five famous physicians who were Nazi
victims. These doctors need to be remembered for their remarkable
contributions [Strous and Edelman, 2007].
Two of these are very well-known in medical genetics:
Ludwig Pick (Fig. 1) (Niemann–Pick disease, types A, B, C1, C2;
Lubarsch–Pick syndrome; Pick cell; Pick retinitis)5 and Simon van
Creveld (Fig. 2) (Ellis–van Creveld syndrome; van Creveld–Gierke
syndrome)5 [Strous and Edelman, 2007]. Pick was imprisoned in a
concentration camp where he died in 1944 [Simmer, 1994; Shevell,
1999]. van Creveld and his wife were both imprisoned in a concen-
tration camp; van Creveld demonstrated great courage treating the
children there [Emed, 2000]. He survived the war and was reinstat-
ed as Professor of Pediatrics.
Lucja Frey (Fig. 3) (Frey syndrome)5 was a Jewish woman
neurologist, whose syndrome is well-known to neurologists. She
was killed by the Nazis [Dunbar et al., 2002; Moltrecht and
Michel, 2004; Maciejewska et al., 2007]. Abraham Buschke
(Fig. 4) (Buschke disease or Busse–Buschke disease,
Buschke–Fischer–Brauer syndrome, Buschke–L€owenstein tumor,
Buschke–Ollendorf syndrome)5 and Karl Herxheimer (Fig. 5)
(Herxheimer disease; Jarisch–Herxheimer reaction)5 were famous
Jewish dermatologists in Germany. Both were professor doctors,
Box 3: Julius Hallervorden
Julius Hallervorden (1882–1965), trained originally as a psychiatrist and later as a neuropathologist, was Professor and Head of the
Neuropathology Department of the Kaiser Wilhelm Institute for Brain Research. He had succeeded Max Bielchowsky, who was
dismissed in 1933 because he was a Jew [Harper, 1996; Shevell and Peiffer, 2001].
At the end of the war, Hallervorden was debriefed about his personal involvement in Action T4, the official Nazi program from
1939 to 1941 in which 250,000 individuals with mental or physical disabilities were systematically killed. He was remarkably frank
[Alexander, 1945; Harper, 1996; Shevell and Peiffer, 2001]:
‘‘I heard they were going to do that . . . (carry out the killings) . . . and so I went up to them and told them, ‘Look here now, boys.
If you are going to kill all those people, at least take the brains out so that the material can be utilized.’ There was wonderful
material among those brains, beautiful mental defectives, malformations and early infantile disease. They asked me ‘how many
can you examine?’ And so I told them an unlimited number—the more the better. I gave them fixatives, jars and boxes, and
instructions for removing and fixing the brains. They came bringing them in like a delivery van from the furniture company. The
public ambulance society brought the brains in batches of 150–250 at a time. I accepted the brains, of course. Where they came
from and how they came to me was really none of my business. Whoever looked sick or was otherwise a problem patient from the
nurses’ or attendants’ point of view was put on a list and was transported to the killing center. The worst thing about this business
was that it produced a certain brutalization of the nursing personnel. They got to simply picking out those whom they did not
like’’ [Alexander, 1945].
During the war, Hallervorden carried out neuropathological examinations on (1) Action T4 victims of Brandenburg–Gordon; (2)
patients from the Leipzig-Dossen Psychiatric Institute, a transfer center for Action T4; (3) child euthanasia victims from various
hospitals; and (4) typhus deaths from the Jewish Hospitals in Warsaw and Lublin [Shevell and Peiffer, 2001]. Hallervorden was never
charged with any crimes and continued his career during the post-war years. During that time, he published 12 scientific articles based
on these Nazi victims [Peiffer, 1991; Shevell and Peiffer, 2001].
He received an honorary doctorate in 1956 and retired as a Professor Emeritus before his death in 1965 [Kr€ucke, 1966; Richardson,
1990; Shevell and Peiffer, 2001]. Ironically, a laudatory biography of Hallervorden is included in an American book titled The Founders
of Child Neurology [Richardson, 1990].
Hallervorden and Spatz, in 1922, described a newly recognized disorder consisting of familial brain degeneration in 5 of a sibship of
12 individuals. Unusual histological features included iron deposition. The syndrome has since been known as Hallervorden–Spatz
syndrome. Harper [1996] suggested that because of the heinous crimes committed during the Nazi era, it is indefensible to use the
names of Hallervorden and Spatz to describe the disorder, even though the original published article in 1922 involved no wrongdoing.
The term neuroaxonal dystrophy has been considered a suitable substitute [Harper, 1996; Strous and Edelman, 2007]. However, the
disorder is now known to be caused by a mutation in the pantothenate kinase gene PANK2 (mutations in the same gene also cause
the allelic disorder HARP syndrome). The abbreviation PKAN stands for pantothenate kinase-associated neurodegeneration.
Therefore, an appropriate term for the disorder is PKAN neuroaxonal dystrophy [OMIM 234200, 2008].
698 AMERICAN JOURNAL OF MEDICAL GENETICS PART A
TAB
LEII
I.Ep
onym
sof
Fam
ous
Phys
icia
ns
Who
Wer
eN
azi
Vict
ims
Nam
esEp
onym
sLi
fesp
anPe
rtin
ent
fact
sLu
dwig
Pick
Nie
man
n–
Pick
dise
ase
Luba
rsch
–Pi
cksy
ndr
ome
Pick
cell
Pick
reti
nit
is1
86
4–
19
44
Wor
ld-r
enow
ned
Ger
man
pat
hol
ogis
t.Im
pris
oned
by
the
Naz
isat
Ther
esie
nst
adt
con
cen
trat
ion
cam
pw
her
eh
ep
eris
hed
onFe
bru
ary
3,
19
44
Sim
onva
nCr
evel
dEl
lis–
van
Crev
eld
syn
drom
eva
nCr
evel
d–
Gie
rke
syn
drom
e1
89
4–
19
71
Fam
ous
Du
tch
ped
iatr
icia
n,
Pro
fess
orof
Ped
iatr
ics
atth
eU
niv
ersi
tyof
Amst
erd
am.
He
was
exp
elle
dan
dim
pris
oned
wit
hh
isw
ifein
aco
nce
ntr
atio
nca
mp
wh
ere
he
bra
vely
trea
ted
child
ren
ther
esu
ffer
ing
from
dis
ease
.H
esu
rviv
edth
ew
aran
dw
asre
inst
ated
asCh
airm
anof
Ped
iatr
ics
Lucj
aFr
eyFr
eysy
ndr
ome
18
89–
19
42
Wel
l-kn
own
syn
dro
me
amon
gn
euro
logi
sts.
Ref
ers
toun
ilate
ral
inju
ryto
the
par
otid
glan
dw
ith
rero
uti
ng
offi
bers
affe
ctin
gth
esw
eat
glan
ds.
On
tast
ing
food
,tr
ansi
tory
flu
shin
gan
dsw
eati
ng
occu
ron
the
face
wit
hab
sen
ceof
saliv
atio
nfr
omth
eip
sila
tera
lp
arot
idgl
and
.Po
lish
Jew
ish
wom
ann
euro
logi
st.
Kill
edb
yN
azis
whi
lesh
ew
asco
nfi
ned
toa
loca
lgh
etto
clin
icAb
raha
mB
usch
keB
usch
kedi
seas
eor
Bus
se–
Bus
chke
dise
ase
Bus
chke
–L€ o
wen
stei
ntu
mor
Bus
chke
–O
llen
dorf
fsy
ndr
ome
Bus
chke
–Fi
sche
r–B
rau
erdi
seas
e
18
68–
19
43
Wor
ldfa
mou
sJe
wis
hP
rofe
ssor
Dr
ofD
erm
atol
ogy
atR
udol
fVi
rch
owH
osp
ital
.W
ith
40
0b
eds,
his
clin
icw
ason
eof
the
larg
est
der
mat
olog
yu
nit
sin
Ger
man
y.
He
was
anex
celle
nt
clin
icia
nan
dte
ach
erw
ith
mu
ltip
leep
onym
s.B
usc
hke
was
dep
orte
dto
Ther
esie
nst
adt
con
cen
trat
ion
cam
pw
her
eh
eex
pir
edin
ad
ebili
tate
dco
ndi
tion
follo
win
gse
vere
ente
riti
sK
arl
Her
xhei
mer
Jari
sch–
Her
xhei
mer
reac
tion
Her
xhei
mer
dise
ase
orPi
ck–
Her
xhei
mer
dise
asea
18
61–
19
42
Wor
ldfa
mou
sJe
wis
hP
rofe
ssor
Dr
ofD
erm
atol
ogy
and
Hea
dof
the
Dep
artm
ent
ofD
erm
atol
ogy
atFr
ankf
urt
Un
iver
sity
.H
ew
asd
epor
ted
toTh
eres
ien
stad
tco
nce
ntr
atio
nca
mp
wh
ere
he
die
din
19
42
from
hu
nge
ran
ddy
sen
tery
Dat
afr
omG
ans
[19
61
],Cu
rth
and
Olle
ndo
rf-C
urth
[19
83
],G
old
and
Nur
nbe
rger
[19
92
],N
otte
r[1
99
4],
Sim
mer
[19
94
],Sh
olz
and
Eppi
nge
r[1
99
9],
Shev
ell
[19
99
],Em
ed[2
00
0],
Dun
bar
etal
.[2
00
2],
Mol
trec
htan
dM
iche
l[2
00
4],
Stef
fen
[20
06
],M
acie
jew
ska
etal
.[2
00
7],
Stro
usan
dEd
elm
an[2
00
7].
aPh
ilipp
Jose
fPi
ck,
not
Ludw
igPi
ck.
COHEN JR. 699
FIG. 1. Ludwig Pick (1868–1944) was a world-renowned German
pathologist and Director of Pathological Anatomy at the City
Hospital in Friedrichshain-Berlin. He was imprisoned in a
concentration camp where he perished. Z. €Arztl Forbild (Jena)
44:43, 1950. From the public domain.
FIG. 2. Simon van Creveld (1894–1971) was Professor of Pediatrics
at the University of Amsterdam. He was expelled by the Nazis and
imprisoned with his wife in a concentration camp. He was very
courageous treating children there. He survived the war and was
reinstated as Professor of Pediatrics in Amsterdam. Instituut voor
Geschiedenis der Geneeskunde, Katholieke Universiteit,
Njimegen, Holland. From the public domain.
FIG. 3. Lucja Frey (1889–1942) was a Polish Jewish woman
neurologist, who had studied mathematics and philosophy as an
undergraduate. After she became a physician, she described the
disorder that bears her name before she became a licensed
neurologist. After struggling through much of her career against
the prejudice of being a Jewish woman physician, she became a
victim of the Holocaust. Wydawnicto, Lekarskie PZWL. From the
public domain.
FIG. 4. Abraham Buschke (1868–1943) was famous as
Professor Doctor of Dermatology at the Rudolf Virchow Hospital.
His dermatology unit, with 400 beds, was one of the largest in
Germany. The large number of dermatologists he trained is his
legacy. There are four medical eponyms that bear his name. As a
Jewish physician, he was sent to a concentration camp where he
died from severe enteritis. From the public domain.
700 AMERICAN JOURNAL OF MEDICAL GENETICS PART A
excellent clinicians, researchers and teachers. Buschke died in a
concentration camp from severe enteritis. Herxheimer also died
in a concentration camp of hunger and dysentery [Gold and
Nurnberger, 1992; Sholz and Eppinger, 1999; Steffen, 2006; Strous
and Edelman, 2007].
Petrus Johannes Waardenburg (Waardenburg syndromes types
I, II, IIA, IIB, IIC, IID, IIE, III or Klein–Waarenburg syndrome;
Waardenburg–Shah syndrome; Waardenburg–Shah-syndrome,
neurologic variant; Waardenburg–Jonkers disease)5 courageously
opposed the racial politics of the Nazis and bravely published
against Nazi racism and anti-Semitism during the occupation
of Holland. He was never incarcerated and died in 1979
[Waardenburg and Jonkers, 1961; Opitz, 1980; Williamson, 1980].
Large numbers of eponyms are attached to many physicians who
fled from the Nazis. Many but not all of them were Jewish. Some fled
for political reasons. Two physicians are well-known to medical
geneticists: Paul George Seckel (Seckel syndrome, types 1, 2, 3,
and 4)5 and Meinhard Robinow (Robinow syndrome, autosomal
dominant and autosomal recessive types)5 [Strous and Edelman,
2007].
RECOMMENDATIONS
I suggest considering the convening of an international com-
mittee of physicians and ethicists, independent of the International
Helsinki Committee, to examine five issues. Perhaps the best way to
FIG. 5. Karl Herxheimer (1861–1942) became the Director of a
Dermatology Clinic at the amazing age of 33. He later became a
famous Professor Doctor and Director of Dermatology at Frankfurt
University. There are two medical eponyms that bear his name. The
German Dermatological Society named their annual award after
him. After his retirement, he refused to take the advice of his
friends to leave his own country. He was sent to a concentration
camp because he was Jewish. He died there from hunger and
dysentery. From the public domain.
Box 4: Eduard Pernkopf
Eduard Pernkopf (1888–1955) was Professor of Anatomy at
the University of Vienna. He joined the Nazi Party in 1933, and
after Hitler invaded Austria in 1938, he was appointed Dean of
the Medical School. Pernkopf was responsible for purging 153
Jewish Faculty Members from the Medical School, including 3
Nobel Laureates. He was an ardent Nazi, and as Editor of the
Viennese Medical Weekly (Wiener Klinische Wochenschrift) in a
1938 address to the Faculty of Medicine, he stated:
To assume the medical care—with all your professional
skill of the Body of the People (Volksk€orper) which has
been entrusted to you, not only in the positive sense of
furthering the propagation of the fit, but also in the
negative sense of eliminating the unfit and defective. The
methods by which racial hygiene proceeds are well known
to you: control of marriage; propagation of the genetically
fit whose genetic, biologic constitution promises healthy
descendants; discouragement of breeding by individuals
who do not belong together properly, whose races clash;
finally, the exclusion (Ausschaltung) of the genetically
inferior from future generations by sterilization and other
means [Pernkopf, 1938].
Pernkopf is best known for his textbook of anatomy
(Topographische Anatomie des Menschen: Lehrbuch und Atlas
der region€ar-stratigraphischen Pr€aparation) [Pernkopf, 1943].
This is a seven volume work written and illustrated between
1933 and finally finished in 1955. Editions have appeared in
German, English, Japanese, and Italian. It is considered the
classic work on the subject among anatomists and surgeons, and
it continues to be used in medical centers throughout the world.
Positive reviews have appeared in the New England Journal of
Medicine [Snell, 1990] and the Journal of the American Medical
Association [Hast, 1990].
Pernkopf ’s illustrated work has become the standard work by
which all other anatomy texts are measured [Williams, 1988].
The original publisher of the illustrated anatomic work was
Urban and Schwarzenberg [Seidelman, 2007]. However, the
book was written and illustrated during the Nazi era with
profound ethical implications for its continued use.
Each illustration by three major artists is accompanied by
each artist’s signature together with a swastika attached. In fact,
even the 1964 English version retains those signatures with
swastikas. These have been airbrushed out in subsequent
German and English versions [Seidelman, 2007].
Pernkopf was concerned about the shortage of cadavers in
1938 and 1939. He requested the use of bodies of executed
victims in occupied Poland from the authorities in Berlin,
but this request was denied. Pernkopf then put pressure on
the administration of Vienna to order all city hospitals not to
dissect bodies, but to turn them over to his institute [Lehner,
1990].
After considerable pressure by William E. Seidelman from
Canada, Howard A. Israel from the United States, and the Yad
Vashem from the State of Israel, the University of Vienna finally
COHEN JR. 701
convene such a committee is as an adjunct to some future interna-
tional medical genetics meeting. The committee should also include
non-geneticists who are knowledgeable about the subject, includ-
ing, among others, William E. Seidelman, Michael Grodin, Robert
Jay Lifton, Howard Israel, E. Ernst, Joel Geiderman, Rael Strous,
and Morris Edelman. A final report can be issued to appear in a
journal of the committee’s choice with a summary issued to all
medical journals together with a notation about the journal refer-
ence in which the report is published.
First, eponyms of those doctors who exhibited complicity during
the Nazi era (see Table II) should be reviewed and alternative names
should be recommended, as suggested by Strous and Edelman
[2007]. Perhaps some of the names need molecular updating, as
I have done for the disorder described originally by Hallervorden
and Spatz (PKAN neuroaxonal dystrophy;5 see Box 3 about Julius
Hallervorden). The case of Pernkopf’s name attached to an anato-
my book (Box 4) is particularly problematic and is discussed
separately in Box 5.
Second, the eponyms of physicians who were victims of
Nazi genocide (or in one case survival of a concentration camp)
deserve special honors and their stories deserve to be repeated
and publicized widely. I have reviewed five such physicians
in Table III. They have also been discussed by Strous and
Edelman [2007].
Third, during the Nazi era, many Poles and Russians
as well as Jews were slaughtered in execution chambers.
Contrary to German law, the bodies were not released for burial
by relatives, but were sent to various university anatomical
institutes [Evans, 1996; Seidelman, 2007]. Some institutes,
after extreme external pressure, held investigations and issued
reports (e.g., University of Vienna) [Seidelman, 2007]. However,
not all have held their own investigations [Seidelman, 2007], and in
these instances, the committee should recommend applying vigor-
ous pressure to those German and Austrian institutes that have not
yet determined if the bodies of Nazi victims remain in their
collections.
carried out an investigation of Pernkopf’s institute [Seidelman,
2007]. An announcement by the Rector, Professor Dr Alfred
Ebenbauer [Presse-Konferenz der Universit€at Wien, 1997],
showed that Pernkopf’s Institute of Anatomy received almost
1,400 bodies from the Gestapo execution chamber of the Vienna
Regional Court (Landesgerichte) [Senatsprojekt der Universit€at
Wien, 1998]. An updating by Daniela Angetter [2000] of the
Department of Medical History showed that 1,377 bodies,
including 8 of Jewish origin, were guillotined at the Vienna
Regional Court, but some of them had been shot by the Gestapo
at a rifle range on the outskirts of Vienna. The names of the
victims, their dates of execution, and the reasons for the
sentences were documented. Most were sentenced for political
reasons, but petty crimes such as pickpocketing, black markete-
ering, unauthorized slaughter of animals, or listening to
enemy broadcasts also carried capital punishment. The Depart-
ment of Histology was also found to have 98 specimens fixed
in formaldehyde as well as histological sections and paraffin
blocks given to the department by Heinrich Gross between 1953
and 1957. These specimens were dated from 1942–1944 and
originated from the children murdered in the Nazi T4
‘‘euthanasia’’ program [Angetter, 2000; Hubenstorf, 2000].
During the last years of the war, victims killed in execution
chambers were supplied from Linz, M€unchen, and Prague
[Lehner, 1990].
After the war, Pernkopf spent three years in Glasenbach, an
Allied prison camp. He was never charged with any crimes, and
following his release, he continued to work on his book in
Vienna until his death in 1965 [Israel, 1998].
Pernkopf’s tainted anatomy volumes have had varied re-
sponses. Riggs [1998] has indicated that the ‘‘use of the atlas
itself is itself the most fitting tribute to those who died for it,
whether they were victims of Nazi repression or not.’’ I regard
this view as a sophistry.
Some have suggested that future editions of Pernkopf’s work
should include an explanation of its tainted background. Pro-
fessor Dr Alfred Ebenauer, speaking on behalf of the The
University of Vienna has stated, ‘‘I agree with the contemporary
efforts of American physicians to add an explanation to the
Pernkopf Atlas’’ [Presse-Konferenz der Universit€at Wien,
1997].
The Yad Vashem [Dafni, 1995] has indicated that the most
appropriate course of action should be (1) an investigation by
outside experts to determine who the subjects were in
Pernkopf’s atlas and how they died and (2) if some of the
subjects were Nazi victims, there should be public commemo-
ration by the responsible institution(s) and future editions of
the book should contain a commemoration to them.
Many authors [Broder, 1996; Israel and Seidelman, 1996;
Panush, 1996; Wade, 1996, 1997; Israel, 1998; Seidelman, 2007]
have addressed the disturbing history of Pernkopf and his book.
Some have even proposed removing the book from circulation,
but Israel [1998] has indicated that suppression of the book is
inappropriate.
Responses by medical libraries have been varied. The medical
library of the National Institutes of Health has placed Pernkopf’s
volume on reserve with a note in the book referring the reader to
a binder of articles describing the biomedical ethical issues
[Grefsheim, 1997]. Another library has expunged Pernkopf’s
book from its collection, but has retained it in a symbolic
manner to remember the lessons surrounding the production
of the book [Panush, 1996]. Some libraries have raised the issue
of how to label controversial material, whereas others have not
[Israel, 1998].
Strous and Edelman [2007] come to the closest to my own
perspective on Pernkopf’s book:
Needless to say, many other anatomy books exist today
that provide significant improvement based on modern
media technology. The use of such a tainted atlas has no
place in modern medical usage.
I recommend some concrete steps that can be taken about
Pernkopf’s anatomy book in Box 5.
702 AMERICAN JOURNAL OF MEDICAL GENETICS PART A
Fourth, McIntye and Popper [1983] have proposed that the
lessons of the past bear repeating, and that an annual commemo-
ration should be held worldwide in medical schools and research
institutes. This would allow reflection about ongoing challenges
together with the role and influence of university physicians and
scientists in medicine.
The commemoration should include a lament for the victims of
medical abuse [Seidelman, 2007]. Memorials to victims and their
remains have been addressed by Seidelman [1989, 1996] and Peiffer
[1991].
Fifth, it is essential to examine the influence of any political
ideology that compromises the practice of medicine. Although it
is perhaps comfortable to believe that what happened in Nazi
Germany could not have occurred elsewhere, the fact is that
atrocities and acts of genocide have been committed at various
times in different places [Baron, 1999].
ACKNOWLEDGMENTS
I am very grateful for the critical reading of my manuscript with
suggestions by Fay Cohen (Halifax), Mason Barr (Ann Arbor), and
Howard Israel (New York).
APPENDIX I
Post-War Increase in Medical Experiments inUnited States PrisonersThe post-World War II era ushered in a dramatic upsurge of
experimentation in US inmates by American physicians, including
studies of athlete’s foot, histoplasmosis, infectious hepatitis, amoe-
bic dysentery, influenza, and flash burns ‘‘which might result from
atomic bomb attacks’’ [United States Department of Justice, 1945;
Butterfield, 1951; Hornblum, 1997].
At the New York State Prison at Ossining, a ‘‘volunteer’’ to
become a ‘‘human blood cleaning agent’’ had his circulatory system
linked with that of a young girl dying of cancer in hope that her
‘‘poisoned blood’’ would be cleaned through the prisoner’s blood
stream. Following the risky experiment, the 8-year-old cancer victim
died, and the prisoner won his freedom [New York Times, 1949].
Researchers from the Sloan-Kettering Institute for Cancer
Research injected liver cancer cells into over 100 inmates from the
Ohio State Prison System. The inmates were told that they
were in ‘‘no grave danger. Any cancer that took would
spread slowly and could be removed surgically’’ [Newsweek,
1956; Hornblum, 1997].
Box 5: Possible Courses of Action on Pernkopf’s Anatomy Book
Four major suggestions have been put forth: (1) to be strong advocates for an introduction to future editions explaining Pernkopf’s
tainted background [Presse-Konferenz der Universit€at Wien, 1997]; (2) to recommend other anatomy texts rather than Pernkopf’s
book [Strous and Edelman, 2007]; (3) to find out who the bodies were that were used for the anatomical drawings [see Dafni, 1995;
Israel, 1998]; and (4) to remove or not to remove the book from circulation (see Israel [1998] for discussion). It has been suggested that
suppression of Pernkopf’s book is inappropriate because it is reminiscent of the burning of Jewish books that occurred during the Nazi
era [Israel, 1998].
It is known that the youthful age, cachectic appearance, and crude haircut of one subject portrayed in Pernkopf’s Atlas raises the
question of possible prisoner status [Israel and Seidelman, 1996; Israel, 1998]. Another illustration is of an adult male with a
circumcised penis [Israel, 1998]. The specific identification of the bodies used for modeling remains unknown to date despite the large
number of executed bodies procured by Pernkopf’s Institute discussed in Box 4. In fact, exact identification of the bodies used for the
drawings perhaps may not be forthcoming because ‘‘the Anatomical Institute and its collections were destroyed by a bomb near the end
of the war’’ [Seidelman, 2007]. It appears not to be known yet if the involved records were also destroyed. However, Pernkopf’s criminal
behavior was so heinous, as shown in Box IV, that the proposed committee might consider issuing a report about Pernkopf’s complicity
during the Nazi era and distributing it to all departments and journals of anatomy and surgery as well as to all medical libraries.
Apparently, there are no plans for further editions of Pernkopf’s book in either German or English [Israel, 1998]. However, we should
still be vigilant for possible further printings, which are not the same as new editions, and we should also be watchful for the possibility of
another publisher producing the book. I have seen a number of instances of both. Should either of these possibilities occur, the
committee might consider applying strictures to Pernkopf’s Atlas that are similar to those applied to the syndromes originally named
after Reiter (see section titled ‘‘Nazi Physicians Who Committed Atrocities and Eponyms of Unethical German Physicians’’) and the
syndrome named after Hallervorden and Spatz (see Box III), and although these have already been discussed, they are briefly
summarized here: (1) An international group of editors of rheumatology journals decided not to permit Reiter’s name to be used in any
of their journal articles [Dendl et al., 2004], and (2) Harper [1996] indicated that because of the Nazi atrocities involving Hallervorden
and Spatz, the use the eponym Hallervorden–Spatz syndrome is indefensible even though the disorder was described in 1922 before the
Nazi era.
Similarly, if another printing should occur, the committee might consider recommending the renaming of Pernkopf’s Atlas on
ethical grounds alone, such as the ‘‘Vienna Atlas’’ or some other name, together with an introduction explaining the book’s tainted
background. Furthermore, a group of journal editors might consider not reviewing any reprinting of the Atlas in their journals. A
decision to rename the book and not review it in any journal does not, of course, preclude further investigation of the bodies used for the
drawings, nor does it preclude commemoration of its victims.
COHEN JR. 703
During the 1960s, Dr. Austin Slough, collaborating with some
pharmaceutical companies, carried out a series of drug tests and
blood plasma projects on prisoners in Oklahoma, Arkansas, and
Alabama. As many as 30 inmates per month contracted viral
hepatitis. One alarmed inmate wrote to the New York Times,
‘‘they’re dropping like flies here.’’ Studies of tropical diseases,
respiratory infections, and pain tolerance studies were also carried
out on prison inmates [Rugaber, 1969; Hornblum, 1997].
At Holmesburg Prison in Philadelphia, inmates were exposed to
dioxin and chemical warfare agents. Research sponsors included
pharmaceutical companies, R.J. Reynolds, Dow Chemical, and the
US Army [Hornblum, 1998].
From 1963 to 1971 medical researchers irradiated the testicles of
healthy male prisoners in Oregon and Washington. They repeatedly
took biopsies, and the inmates reported rashes, pealing, and blisters
on the scrotum, as well as sexual difficulties [Lerner, 2007].
In Tuskegee, Alabama, a study of untreated syphilis was carried
out on 399 black prisoners from 1932 to 1972 under the auspices of
the venereal disease section of the U.S. Public Health Service. These
inmates had deliberately been left untreated for 40 years so that
medical researchers could study the natural course of the disease
[HR 16160, 1974]. The prisoners were not informed of their
diagnosis. Instead, they were told that they had ‘‘bad blood,’’ and
for their cooperation, they could receive free medical treatment,
free rides to and from the clinic, hot meals on examination days, and
burial insurance in case of death [Olansky et al., 1954; Schuman
et al., 1955; Jones, 1981; Reverby, 2000].
When the study began in 1932 standard treatments for syphilis
were toxic, dangerous and of questionable effectiveness. By 1947,
penicillin had become the standard treatment.
However, Tuskegee doctors withheld penicillin and also infor-
mation about penicillin as well. The ‘‘special treatment’’ that the
prisoners received consisted of (1) diagnostic lumbar puncture for
signs of neurosyphilis and (2) free treatment for minor ailments
[Kampmeier, 1972, 1974; Jones, 1981; Reverby, 2000].
A 1972 Associated Press story led to public awareness of the
Tuskegee experiment [Heller, 1972]. At that time, with the black
power movement and protests of the Vietnam war in full force,
widespread condemnation was immediate [HR 16160, 1974;
Tyler and Carlson, 1975; Lerner, 2007]. A National Commission
for the Protection of Human Subjects of Biomedical and Behavioral
Research was set up and, later, the ‘‘Belmont Report, which
recommended revamping human experimentation using the
principles of respect for persons, non-maleficence, and justice’’
[Lerner, 2007].
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